How dermatologic research can get its groove back

Experts say mentors and funding are crucial

The skin is the largest organ in the human body, and that's not all. It's exposed to sunlight and countless other hazards from bacteria to bug bites, and when things go wrong the consequences can be fatal.

Despite these facts, the world of medical research devotes fairly little attention to dermatology. And dermatologists themselves tend to avoid careers in research.

Dr. Gilchrest"A very small proportion of the entire population of dermatologists are doing laboratory research. Below 10%, maybe 5%," says Barbara A. Gilchrest, M.D., of the department of dermatology at Massachusetts General Hospital. "That's a small fraction compared to other fields like neurology or internal medicine in general."

Now, the dermatology research gap is getting more attention.

"Unfortunately, today’s financially austere research climate presents unprecedented regulatory and funding threats to both junior and senior researchers," the authors wrote. "To continue to conduct high-quality research that advances patient care, the field of dermatology must identify the dermatologic researchers of tomorrow and prepare them to tackle the challenges that lay ahead."

To shed light on the problem, Dermatology Times reached out to Dr. Hartman, Dr. Gilchrest and commentary co-author Alexa B. Kimball, M.D., MPH, president and chief executive officer (CEO) of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and professor of dermatology at Harvard Medical School. They all provided perspective about the challenges and solutions on the dermatologic research front.

Inside the Research Funding Gap

Dermatologic research lacks the sexiness of other kinds of research. But why?

A commentary in The Journal of Investigative Dermatology1 notes that "there has historically been a tendency to trivialize dermatologic diseases because of their nonfatal nature, and as a result, less research funding has been devoted to them."

Indeed, a 2014 study2 found that the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases devoted only 18% of its $424 million fiscal 2013 budget to skin conditions. Researchers discovered that several conditions -- including acne vulgaris, viral skin diseases, fungal skin diseases, scabies and melanoma -- were funded at lower levels than their disability burden suggests they deserve.

There is some good news, however.

"Despite the shortage of funding, dermatology research is growing, with increasing publications and new treatments for a number of diseases including hidradenitis suppurativa, eczema, and alopecia areata," Dr. Hartman says.

And Dr. Gilchrest says there's "exciting new therapy" in the melanoma field, much of it based on basic work by dermatologists.

"Cancer therapies are often more lucrative for pharmaceutical companies," says Dr. Gilchrest, who added that there's also extensive research into psoriasis.

Dr. KimballStill, the three dermatologists interviewed for this story find plenty of reason for concern. "The areas that remain vulnerable are basic science, where funding is scarcer than ever, and clinical trials, which require large dollars in order to complete investigations," Dr. Kimball says.

Money Isn't the Only Issue

Even when funding is available, young dermatologists often reject a career in research. Pay is one issue.

"The private practice of dermatology can be quite lucrative, and that's a temptation dangling out in front of people," Dr. Gilchrest says.

Even when academics manage to woo dermatologists from careers in private practice, many end up on the clinical side instead of working on research.

"Graduating residents are finding academia quite appealing currently, with academic jobs are becoming increasingly popular and more competitive. That’s a change from previous years," Dr. Kimball says. "But the research career trajectory is more complicated and uncertain than it used to be. The clinical needs of academic centers have changed, and there are more types of career tracks today in academia than ever before, some of which aren’t dedicated to research."

There's yet another complication that affects dermatologic research. Unlike some other specialists, dermatologists often don't practice in a hospital setting "where it's relatively easy to do research," Dr. Gilchrest says.

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